Provider Demographics
NPI:1760764484
Name:IPTA CLINICAL, LLC
Entity Type:Organization
Organization Name:IPTA CLINICAL, LLC
Other - Org Name:3 DIMENSIONAL PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-257-3750
Mailing Address - Street 1:175 ROUTE 70
Mailing Address - Street 2:SUITE 19
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2300
Mailing Address - Country:US
Mailing Address - Phone:609-714-3378
Mailing Address - Fax:856-583-6004
Practice Address - Street 1:175 ROUTE 70
Practice Address - Street 2:SUITE 19
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2300
Practice Address - Country:US
Practice Address - Phone:609-714-3378
Practice Address - Fax:856-583-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ235216Medicare PIN